Framework for a Multidisciplinary Approach to Low Vision · 2017-10-12 · Multidisciplinary...

© The College of Optometrists 2001

Framework for a MultidisciplinaryApproach to Low Vision

Multidisciplinary Approach to Low Vision

FRAMEWORK FOR A MULTIDISCIPLINARY APPROACHTO LOW VISION

1 INTRODUCTION ................................................................................ 5

2 BACKGROUND .................................................................................. 6

3 LOCAL LOW VISION SERVICES COMMITTEE ................................. 7

4 OBJECTIVES ....................................................................................... 8

5 ANTICIPATED KEY BENEFITS. ......................................................... 9

6 SCOPE OF SCHEME........................................................................... 9

7 TRAINING AND ACCREDITATION ................................................. 10

8 FUNDING.......................................................................................... 10

9 EVALUATION AND AUDIT.............................................................. 11

BIBLIOGRAPHY ..................................................................................... 13

APPENDIX A: SERVICE MODELS......................................................... 15

APPENDIX B: INTERVENTION “SNAKE” ........................................... 21

APPENDIX C: TRAINING PROGRAMME RECOMMENDED BYTHE TRAINING COMMITTEE OF THE LOWVISION SERVICES CONSENSUS GROUP: TRAININGTO MEET THE NEEDS OF THE LOW VISIONREPORT ......................................................................... 22

APPENDIX D: PROFESSIONALS INVOLVED IN LOW VISIONSERVICES....................................................................... 30

Contents

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1.1 Demographic changes and improvements in health care have led to an

increasing elderly population and longer life expectation. Emphasis is

laid on older people retaining their independence in the community,

yet for a variety of reasons current service provision does not always

meet the needs of this vulnerable group. Visual impairment affects all

age groups but predominantly older people and therefore the demand

for low vision services is likely to increase.

1.2 The Low Vision Services Consensus Group, which included

representatives from the healthcare professional bodies, the

Department of Health, the voluntary sector and Social Services,

published its report Low Vision Services: Recommendations for future

service delivery in the UK in 1999. The report describes the current

variable and fragmented service and makes recommendations for a

cohesive multi-disciplinary approach to the provision of low vision

services. In particular it recommends the establishment of local low

vision service committees, involving the skills of the many

professionals who contribute to low vision service provision.

1.3 This College document sets out a framework for a multi-disciplinary

service, based around a local low vision service committee. The

framework can be adapted and developed locally in negotiation with

the local health services and health care and social services professions

in order to improve local provision. The framework is not prescriptive

but is an illustration of good practice; it is there to stimulate discussion

at a local level. The document relates only to adults with visual

impairment.

1.4 Where reference is made to Health Authorities, Primary Care Trusts

(PCTs) and Local Optometric Committees (LOCs), this should also be

understood as referring to the equivalent structures for Scotland, Wales

and Northern Ireland. Each UK region may develop the

recommendations in the Consensus Group report in different ways.

1 Introduction

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2.1 There is evidence that there is presently a high level of unmet need for

low vision (LV) services:

• Two out of every five service providers questioned as part of

research undertaken by RNIB and Moorfields Eye Hospital in 1999 do

not offer any low vision services at all.• There are parts of the UK where prevalence of low vision is high but

where there are no services at all.• Although it is widely recognized that registration as blind or partially

sighted is not a comprehensive indicator of disability, this is still usedby some services as the sole criterion for acceptance.

• Statistics for registered blind and partially sighted underestimate thetrue extent of registerable visual impairment in the population by twoto three-fold.

2.2 Low vision aids (LVAs), which are typically magnification devices of

variable sophistication, are usually provided on a free loan basis from

the Hospital Eye Service (HES). A patient obtaining a low vision aid

from a community optometrist would have to pay for this service.

Accessing the HES and attending follow up appointments can be

difficult for people with visual impairment (many of whom are older)

and therefore the system is not conducive to patient compliance.

2.3 The philosophy of any local service should be to:

• Promote independent living for people with visual impairment• Ensure a multi-disciplinary approach by involving as many

professional groups as possible, e.g. rehabilitation workers, sensoryneeds teams, orthoptists etc.

• Identify and meet unmet need for low vision services within adefined area and establish or improve a community based LV schemeto meet local needs

• Ensure that those people who are visually impaired are able to accessall services available to them including visual impairment teams andvoluntary organisations

• Increase awareness by community of the benefits of low visionservices

• Take account of the needs of patients with other sensory, physical orlearning disabilities.

2 Background


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3.1 The local low vision services committee is the forum within which the

local scheme and protocol should be drawn up and agreed. Key

stakeholders who will normally be represented on the local committee

are:

• Service users

• The PCT

• The HA

• Ophthalmology department

• LOC

• Community optometrists and dispensing opticians

• Social Services teams for visual impairment

• Voluntary organizations

• GPs within the PCT

In addition, stakeholders could include a representative of any locally

available practitioners with low vision experience, whether hospital- or

general practice-based, and any other low vision practitioners as

appropriate

3.2 It is envisaged that the local low vision services committee would

establish a smaller project team to implement and monitor the scheme

and appoint a project coordinator who will act as the focal point for

collating reports and overseeing the scheme’s operation.

3 Local Low Vision Services Committee

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4.1 Local schemes will reflect local conditions but in general terms the

specific objectives of a low vision service will be geared towards the

philosophy set out at paragraph 2.3 above and will be:

• To identify and meet the level of unmet demand for LV services in

the community and to improve the availability and accessibility of LV

services to people in the community

• To respond to the needs expressed by people who are visually

impaired and to gain a greater understanding of and insight into the

needs of LVA users and carers as they pass through the healthcare

system

• To promote and develop inter-professional team-working in order to

achieve a multi-disciplinary service delivery

• To ensure that any information given to patients is in the appropriate

format

• To ensure that visually impaired people who would benefit from

LV services are referred for assessment as soon as visual impairment

is recognised

• To agree and follow locally agreed protocol for referral to the scheme

• To agree the level of details and appropriate timing of written and

verbal information/communication between key stakeholders

• To provide review/follow-up and monitoring to ensure effective use

of any aids dispensed

• Although BD8 certification is not a prerequisite for any low vision

service, where this is appropriate to ensure that it is completed

quickly and efficiently. (Form A655 in Northern Ireland and BP1 in

Scotland)

• To ensure that all appropriate medical interventions are being or

have been employed to improve an individual’s eyesight and/or help

to retain eyesight.

• To ensure that the scheme allows for re-referral or self-referral to

allow further access to a low vision service provided appropriate

information is available and the GP is informed of attendance.

4 Objectives


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5.1 Key benefits are anticipated as:

• Improved standards of care for visually impaired people resulting

from a more comprehensive service and consequent improvement in

quality of life.

• A more accessible, community-based service

• Substantial reduction in waiting times for access to the service

• Potential to meet current unmet demand

• Improved team-working and communication between professionals

and therefore faster notification of people with visual impairment.

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5 Anticipated Key Benefits

6 Service Models

6.1 Low vision services should be in line with the common services and

standards set out in the Low Vision Services Consensus Group report.

The scheme should be able to deliver high quality services with multi-

disciplinary input for people with visual impairment resident within a

defined area, at a location that is convenient to the patient and

appropriate to the task. Initially this may be over a set period, for

example as a pilot scheme, for audit purposes. Figures and timescales

will need to be reviewed as the scheme progresses. All local

community optometrists and relevant Social Services or voluntary

agencies within the PCT should be invited to participate and should be

offered the opportunity and training to provide LV services within this

pilot.

6.2 The objectives set out at 4 above may be met in a number of different

ways and by involvement of a wide range of professionals. Appendix

A contains six service models; these are all examples of existing

schemes currently in operation and demonstrate the variety of schemes

that can be developed.

6.3 It will be necessary to devise a recording system that allows all the

members of the multi-disciplinary team to use the information. Further

information about service models can be obtained from the Head of

Professional Services at the College of Optometrists (42 Craven Street,

London WC2N 5NG, Tel: 0207 839 6000, fax 0207 839 6800

Email: [email protected])


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7.1 All optometrists and dispensing opticians who wish to participate

should undergo a training programme agreed locally as part of the

scheme’s protocol, leading to accreditation to be part of the scheme.

The programme will be determined according to local needs but

should be based on the training programme produced by the joint

training committee of the Low Vision Services Consensus Group. The

training programme is attached as Appendix C. A mechanism for

ongoing accreditation should be built into the training programme.

7.2 Achievement of a multi-disciplinary service is greatly aided by the

various professionals involved training together. This enhances

communication and mutual understanding of professional roles.

7 Training and Accreditation

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8 Funding

8.1 For a scheme to succeed adequate funding has to be available and

this issue has to be addressed as part of the scheme’s development.

NHS priorities as set out in the NHS Plan and the National Service

Framework for Older People highlight the need for services to work in

a multi-disciplinary way. Multi-disciplinary services are therefore more

likely to attract funding from local health service commissioners. If

schemes are to succeed, there will need to be properly identified

funding streams to ensure the provision of appropriate clinical services

and community provision of low vision aids. Without this, an

improved service delivery will not be achieved.


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9.1 The purpose of audit is to improve standards and develop future

services. In order to determine the effectiveness of the scheme,

adequate numbers of people who are visually impaired need to be

recruited and a manageable number referred to the scheme. These

figures should be reviewed regularly and the guidelines for inclusion

in the scheme may need to be adjusted in line with the findings of

these reviews. For audit to be of any value, it is important to utilize all

available resources and expertise, for example hospital-based services

have access to experienced clinical audit staff with ophthalmology

experience. Schemes should be reviewed on a regular basis and

should encompass multi-disciplinary audit, including service users.

9.2 Audit should include the following areas:

• Number of patients

• Patient demographics

• LVAs issued – design and magnification

• Level of visual acuity

• Patient satisfaction/quality of life

• Inter-professional relations

• Appropriateness of referrals

9.3 Outcomes of audit should include

• Recommendations for future development of the service based on

audit findings

• Agreed standards of communication between key stakeholders and

service users

• Identified method of multi-agency planning for the future

• Identified workstreams for primary and secondary care

• Clear referral criteria to secondary care

9 Evaluation and Audit

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Baker M, Winyard S. Lost Vision: Older Visually Impaired People in the UK.; London, 1998, Royal NationalInstitute for the Blind.

Bruce I et al. Blind and partially sighted adults in Britain: the RNIB survey. 1991, London; HMSO

Evans, J. Causes of blindness and partial sight in England and Wales, 1990-1991. Office of PopulationCensuses and Surveys. Studies on medical and population subjects, London 1991, HMSO.

Harries V, Landes R, Popay J. Visual disability among older people: a case study in assessing needs andexamining services; Journal of Public Health Medicine. 1994; 16(2): 211-8

Low Vision Services Consensus Group. Low Vision Services: Recommendations for future service delivery inthe UK. RNIB 1999.

Reidy A, Minassian DC, Vafidis G et al. Prevalence of serious eye disease and visual impairment in a NorthLondon population: population-based, cross sectional study. BMJ 1998; 316: 1643-1646

Robinson R, Deutsch J, Jones HS et al. Unrecognised and unregistered visual impairment. Br J Ophthalmol.1994; 78: 736-740

Royal College of Ophthalmologists. Registration and Rehabilitation of the Visually Handicapped. 1994

Ryan B and Culham L. Fragmented vision: survey of low vision services in the UK. RNIB & Moorfields EyeHospital NHS Trust 1999.

Social Services Inspectorate. A Sharper Focus: inspection of services for adults who are visually impaired orblind. CI(98)8. 1998

Wormald RPL, Wright LA et al. Visual problems in the elderly population and implications for services. BMJ1992; 304: 1226-1229

Wormald R and Evans J. Registration of blind and partially-sighted people (editorial). Br J Ophthalmol.1994; 78: 733-4

Population Trends (PT) 101, Autumn 2000, © Crown Copyright 2000.

National population projections:1998-based, National Statistics, © Crown Copyright 2000, Actual andprojected population by age, UK, 1998-2021.

National Service Framework for Older People, London 2001, Department of Health.

National Service Framework for Diabetes, London 2001, Department of Health.

NHS Executive, National Health Service Plan, London 2001.

Registered Blind and Partially Sighted People. Year Ending 31 March 2000. England. DOH A/F 2000/7

Both the National Service Frameworks are available free of charge at: www.doh.gov.uk/nsf/diabetes

The NHS plan is available free of charge at http://www.doh.gov.uk/nhsplan/

Members of the College of Optometrists Low Vision Project Group

Mr David Bennett MCOptomDr Helen Farrall FCOptomMrs Lindy Greenhalgh FBDO (Hons)LVAMiss Jennifer Lindsay MCOptomDr Thomas Margrain PhDDr Martin Rubenstein FCOptom Dr Michael Wolffe JP FCOptom

The Group gratefully acknowledges input from Mrs Mary Bairstow MCOptom, Low VisionImplementation Officer.

Bibliography


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Appendix A: Service models

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Singleton hospital Swansea and Swansea Social Services (Sensory Needs)


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Appendix B: Intervention “snake”

Reproduced by kind permission of Mr Richard Cox, Training Consultant, RNIB


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Introduction

The report on low vision services launched in July 1999 identified a

number of problems, which reduced the effectiveness of low vision

services in the UK. There is a wide disparity between different parts

of the country in both the quantity and the quality of services. There

is also a fragmentation of services, a lack of multi-disciplinary and

multi-professional working, inadequate communication between those

providing services, and a lack of information for service users and

potential users. The report recommends an infrastructure necessary for

the provision of a low vision service and identifies the features of a

good quality, responsive service.

Closer co-operation between service providers is an essential

requirement for a service which meets the needs of people with a

visual impairment. Those involved need to know, at a local level, what

others can and do provide, understand the benefits and limitations of

the different services available, and ensure that, in meeting the

technical requirements that they are individually providing, they do not

overlook other needs which might be met by different professionals.

In addition, if the standard of service is to be more uniform across the

nation, individuals need to understand and accept what they

themselves should be providing.

The training outcomes set out below describe the minimum level of

knowledge that is required of those involved in providing a low vision

service. They are not, and are not intended to be, a syllabus of training

but a set of guidelines that those designing and providing training for

the different professionals in a low vision team can use.

Some professionals will need merely to fill gaps in their existing

knowledge, while others will need to acquire new knowledge and

skills, but all will need to keep their knowledge up to date as part of

their continuing professional development. Training designers will

need to draw out the content of these learning outcomes as

appropriate to meet the needs of the group for which they cater.

Individuals will obviously have a deeper level of knowledge in their

own area of expertise. These learning outcomes give a foundation of

the knowledge and skills that are required by all members of the team.

DefinitionsIt may be helpful to restate the definitions, which were contained in

the document “Low Vision Services: recommendations for future

service delivery in the UK”.

Appendix C: Training to meet the needsof the Low Vision Report


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A person with low vision is one who has an impairment of visual

function for whom full remediation is not possible by conventional

spectacles, contact lenses or medical intervention and which causes

restriction in that person’s everyday life.

Such a person’s level of functioning may be improved by providing

low vision services including the use of low vision aids, environmental

modification and/or training techniques.

The definition includes, but is not limited to those who are registered

as blind and partially sighted.

A low vision service is a rehabilitative or habilitative process, which

provides a range of services for people with low vision to enable them

to make use of their eyesight to achieve maximum potential.

This is not just a technical process. The services should include:

• planning the rehabilitative process, setting goals and support in

understanding the limitations involved

• addressing psychological and emotional needs

• assessing the person’s visual function and providing aids and training

• facilitating modifications to the home, school and work

environments.

The support will need to extend to the needs of carers, especially the

family.

Learning OutcomesIt is important to note that these learning outcomes are intended to

reach across the whole age range. Attention must be given to the

infant and the child as well as to the needs of older people. Issues

such as the speed of processing information are not specifically

mentioned, but must be taken into account when designing an

appropriate training syllabus.

In the following learning outcomes where the word “describe” is used

it includes “a knowledge of” and “an understanding of”. Unless they

are read within this context the result could be the rote learning of

some of the suggested elements. For example, it would be relatively

easy to learn about the whole range of low vision aids without having

an understanding of their particular uses, advantages and

disadvantages.

Appendix C


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Vision, the Visual System and Common Pathologies

Workers in the field of low vision need to have a sound understanding

of the way vision works and some of the common causes and

consequences of malfunctioning. This section provides a basic

understanding of the structure and function of the visual system, the

effects of ageing and common diseases.

1. Describe the basic anatomy, physiology and functions of the

component parts of the human visual system.

2. Describe the development of the human visual system and the

effects of ageing on visual function including visual acuity, refractive

error, senescence of vision, senile miosis, media opacities and

accommodation.

3. Describe human visual perception in terms of visual field and visual

field differences in contrast/form perception, motion perception and

colour perception.

4. Describe the common diseases affecting the component parts of the

human visual system, their treatment and the consequent visual and

behavioural implications.

Optics and Visual Optics

It is necessary for workers in low vision to have a sound understanding

of normal and abnormal image formation and the various methods of

manipulating three of the primary factors of vision, contrast, light and

size, both individually and in combination. This section provides a

basic understanding of light, wavelength, range of illumination,

refraction of light, image formation and visual optics.

1. Describe the properties of lenses including cylinders and spheres.

Define the term dioptre and the relevance of using vergence

measures in optical calculations and draw a ray diagram through a

convex and concave lens.

2. Describe what is meant by the terms myopia, hypermetropia and

astigmatism and how these refractive errors are corrected.

3. Explain and demonstrate an understanding of the principles

involved in magnification.

4. Describe a range of magnifying systems, including hand/stand

magnifiers, telescopes, spectacles and compound magnifiers, and

how they can be used most effectively.

5. Describe the different types of light source/luminaire including their

relative efficiency, spectral output and suitability for different tasks

such as the identification of colour, texture and contrast.

Appendix C


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Assessment of Vision

It is widely accepted that low vision work must start with an accurate

refraction and clinical assessment. It is equally accepted that functional

assessment is an essential part of the whole assessment process. It is

vital that workers providing an effective low vision service are familiar

with both aspects of the assessment process. This section provides a

basic understanding of the principles involved in the assessment of

vision in a person who has a visual impairment. It must be stressed

that there are considerable differences between the assessment of

someone with normal or near normal vision and someone with a visual

impairment.

Note. For the purposes of this document the term “clinical assessment”

means the part of the assessment which can be measured and retested.

“Functional assessment” means the assessment of the behaviours of an

individual with a visual impairment, for instance whether body contact

is made during travel, whether a spoonful of sugar can be accurately

placed in a cup and so on.

1. Demonstrate an understanding of the principles involved in the

refraction, clinical assessment and functional assessment of a service

user who has low vision.

2. Demonstrate an understanding of the use of vision in relation to

tasks of daily life such as reading, face recognition and mobility.

Using vision effectively

It is essential that workers in the field of low vision are able to use the

whole range of seeing techniques in helping someone with a visual

impairment to make the best use of their vision. These techniques will

not necessarily involve the use of optical devices. This section

provides an understanding of the various ways of helping people with

a visual impairment to use their vision in the most effective way.

1. Describe and explain, using appropriate terminology, the nature of

light, colour and contrast and their importance in visual

impairments. Demonstrate a knowledge and understanding of the

methods of measuring illuminance.

2. Demonstrate a knowledge and understanding of the physical/visual

environment, both indoor and outdoor, and the consequent

implications for people with a visual impairment in terms of

orientation, navigation and comprehension.

3. Demonstrate a knowledge and understanding of the range of non-

optical devices currently available including typoscopes, visors and

torches and the ways in which service users can be encouraged to

use these in developing effective seeing strategies.

Appendix C


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4. Describe the interaction and integration of optical and non-optical

devices and their use in the management of visual impairment

indicating which ones may be used in isolation and which in

combination.

5. Demonstrate a knowledge and understanding of seeing strategies

including scanning, tracking, location, fixation, steady eye strategy

and preferred retinal locus.

Communication and Interpersonal Skills

In order for workers in the field of low vision to offer the maximum

assistance to people with a visual impairment they need to understand

its social and emotional consequences and be able to communicate

positively and effectively with service users. This section provides an

understanding of the social and cultural implications of impairment,

particularly visual impairment, and how to develop and use

appropriate communication skills as an essential part of the continuum

of care.

1. Understand and explain the psycho-social implications and the

social and cultural consequences of visual impairment for the

lifestyle, aspirations and coping abilities of the individual and

his/her carers. Describe how visual impairment can affect people’s

lives, including the difficulties involved in coping with deteriorating

vision.

2. Demonstrate a knowledge and understanding of children and adults

with a visual impairment who have additional needs, for example

those with a combined loss of hearing and vision and know how to

access additional communication support when necessary.

3. Practise basic skills in providing emotional support and be able to

use them positively with service users and their carers. Demonstrate

good listening, communication and support skills.

4. Demonstrate an ability to communicate with children in a manner

appropriate to their maturity, and possible other special needs, and

interpret their visual obstacles.

5. Interpret professional technical knowledge and terms in a form

which facilitates the ability of the service user, and those with whom

they are associated, to understand in the process of coping with the

consequence of their visual impairment.

6. Demonstrate an understanding of the perspective of the service user

in learning to use devices and techniques effectively.

Appendix C


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Professional and Inter-professional Low Vision Work

Professional workers involved in providing a low vision service need

to have effective communication skills and an ability to interpret

technical terms and concepts in a way which is understandable to the

service user and their carers as a part of the process of rehabilitation.

This section stresses the importance of understanding the roles and

limits of the various professionals involved in a comprehensive low

vision service and the essential element of cross-profession working.

1. Demonstrate an understanding of the roles, limits and

interdependencies of the other members of the low vision team and

other relevant professionals, inter- and intra-professional referral

routes and the importance of working constructively with all

professionals.

2. Demonstrate a knowledge and understanding of the process of

certification and registration either as a blind person or a partially

sighted person.

3. Demonstrate a broad knowledge of benefits and community

services.

4. Demonstrate a knowledge of the structure and organisation of

educational and employment services provided to children, students

and others with a visual impairment.

5. Understand, interpret and explain a range of relevant professional

reports.

6. Write a professional report which can be understood and utilised by

others.

7. Identify appropriate resources and procedures for acquiring

additional relevant information about an individual’s background,

potential, current visual status and financial and social support

whilst maintaining appropriate confidentiality.

Appendix C


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Appendix C

Annex 1 The UK Low Vision Service

Identification Diagnosis

Diagnosis andsurgical/medicalintervention by

ConsultantOphthalmologist

Re-enterbecause ofchanges incondition,

needs,or LV aids

Psychological and emotional support throughout the service

Assessment Provision Follow up andreassessment

Information abouteye condition

Informationabout services

Needsassessment

Visual functionassessment

Refraction

Education intechniques

Opticalcorrection

Provisionof LV aids

Trainingin use of

Vision, mobilityAnd LV aids

Primary HealthCare (including

ophthalmicservices)

Changes toenvironment

Assessment ofenvironment

Registrationas blind or

partially sighted

Others (includingSelf-

Identification)

Recover, repairand re-use

LV aids

Certification ofEligibility forregistration

Hospitalservices

Educationservices

Socialservices

Employmentservices

Identificationof LV aids

Voluntaryorganisations


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Members of the Low Vision Services Training Working Party

Jeff Bashton Department of HealthBrenda Billington Royal Berkshire & Battles HospitalsRichard Cox Royal National Institute for the BlindLouise Culham Moorfields Eye HospitalJohn Davis Birmingham FocusAlbert Dowie Association of British Dispensing OpticiansFred Giltrow-Tyler Association of OptometristsBob Greenhalgh Partially Sighted SocietyJohn HillbourneChris Kersey British Orthoptic SocietyRoy Lawrenson Guide Dogs for the Blind AssociationTom Margrain University of CardiffElizabeth G Percy Henshaw’s Society for the BlindKeziah Petre Aston UniversityPaul L Quin UKCPVILyn Steele Rehabilitation WorkersMichael Wolffe College of OptometristsJohn Wood NALSVI

Appendix C


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There are a number of different professionals who specialize in

working with people who have low vision, either as individual

practitioners or as part of multi disciplinary teams. In most cases their

low vision work forms part of their wider broader professional role.

Dispensing opticiansThe Association of British Dispensing Opticians offers a unique

qualification in low vision (Diploma in low vision) to both dispensing

opticians and other professionals. Only dispensing opticians and

optometrists can fit some of the more complex spectacle mounted low

vision aids such as telescopic devices. Many of the low vision services

in hospitals and in the community are provided by dispensing

opticians.

Education Support Services and Specialist Teachers for childrenwith a Visual ImpairmentThe educational support given to children at school is organised by the

Local Education Authority (LEA) which provides funding for specialist

teachers including teachers for the visually impaired. Because these

teachers travel from school to school, they are called peripatetic or

visiting teachers and in the main, these teachers are based at a central

support service. In some cases, teachers maybe based at an

additionally resourced school which has a special disability unit within

its main stream provision. To qualify as a specialist teacher for the

visually impaired, a teacher with existing teaching experience must

complete a one-year diploma in special educational needs with a

special focus on visual impairment.

Occupational TherapistOccupational therapists may be Community based, employed by

Health or Social Services, or Hospital based in a intermediate care

team. They provide a range of activities to help people maintain and

develop skills to live independently. Assessments involve the the

analysis of tasks and the application of problem solving solutions.

Occupational Therapists are well established in Low Vision teams in

Australia and Europe where they carry out a therapy and ergonomics

role.

Ophthalmic nursesOphthalmic nurses are trained nurses who have taken extra

qualifications in the area of ophthalmology. They are based in

specialist eye hospitals and eye departments of local hospitals. The

role of ophthalmic nurses in Low Vision is currently being developed,

in some areas Nursing staff carrying out a low vision therapy role –

Appendix D: Professionals involved inLow Vision Services


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following up clients and instructing in use of eyesight and devices.

Further to this many nurses have undertaken training to support people

at the time of diagnosis (either by training in counseling or by

undertaking the RNIB/City University – Eye Clinic liaison course).

OphthalmologistOphthalmologists are medically trained and have specialised in treating

eye disease. They are based mainly in the hospital eye service at local

district or specialist eye hospitals. Their primary function is to treat eye

disease medically or surgically. In a few areas ophthalmologists with

a special interest in low vision conduct low vision assessments or work

as part of a multi disciplinary low vision team.

OptometristsOptometrists are trained to assess for, prescribe, fit and supply

spectacles and contact lenses. They also detect, manage and treat eye

disease, and refer on for medical treatment where appropriate. Their

training includes low vision and they are examined in this subject in

their professional qualifying examinations. The majority of

optometrists work in community practices and some are employed

directly by hospital eye services. The majority of low vision services in

the UK are currently delivered by hospital optometrists.

OrthoptistsOrthoptists’ primary role is in the management of binocular function

and assessment of vision in children and adults in a hospital or

community setting. They are involved in many aspects of eye service

delivery across the UK. The role of orthoptists as low vision therapists

has been established in Low Vision work in Australia for some time and

in the UK there are a growing number of orthoptists working in Low

Vision teams.

Rehabilitation Services and Specialist Rehabilitation workers forpeople with a visual impairment Currently rehabilitation services for people with a visual impairment

are provided under Community Care provision set out in The National

Health and Community Care Act 1990. This sets out the current

responsibilities of care provision with emphasis on multi-agencies

planning to address a person’s needs.

This assessment for community care is usually provided by a sensory

disability team staffed by rehabilitation workers or a general social

services team using social workers with a specialist interest in visual

impairment. In some areas the Social Services Department or local

authority have contracted out this provision to the voluntary sector.

Appendix D


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The rehabilitation worker provides an assessment of a person’s needs

concentrating on helping a person overcome difficulties with everyday

tasks. In many areas they also provide a distinct low vision therapy

service. The assessment of a client can lead to a range of other services

being provided by social care or medical teams.

Rehabilitation workers as a professional group are quite new, being an

amalgamation of two previous professions, mobility officers and

technical officers although these professions still provide services in

many areas. They have a separate career path to social workers with

the current qualification being a DipHE qualification.

Social workers

Social workers assess an individual’s care needs and in the absence of

a sensory needs team they provide home based support services to

people with low vision. In complex cases a social worker can act as a

care manager co-ordinating the various services an individual receives.

Local authority social services, local voluntary organisations and

hospitals employ social workers.

Low Vision TherapyThe term Low Vision Therapy is used in the UK to describe a role

carried out by number of different professionals who work with people

with low vision.

The role includes

• assessment of functional vision

• assessment and use of device (optical and non- optical)

• vision reinforcement and enhancement techniques

• lighting, glare and contrast assessment

• ergonomics and posture advice

• use of distance vision and mobility.

Therapy work can exist as a separate service or be integrated into the

overall rehabilitation work being conducted.

Appendix D

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